CASE LOGS &CLINICAL PROCEDURE

TRACKING

M. Njoku, MDUMMC DIO, Chair GMEC

GMEC MeetingJune 25, 2015

Case Logs & Clinical ProceduresUMMC Programs

Call for Action

• ACGME Program-Specific Citation CategoryEducational Program—Patient Care Experiences

7 citationsEducational Program—Procedural Experiences

9 citations• NAS 2015 Letters of Notification

4 Programs with case log AFI’s (Areas for Improvement)

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Specialties Required to UseACGME Case Log Data Collection

Hospital-Based Medical Surgical

Anesthesiology Dermatology* Surgery

Obstetric Anesthesia Neurological Surgery

Medical Genetics Critical Care

Nuclear Medicine Ophthalmology

Pathology Orthopaedic Surgery

Cytopathology Orthopaedic Trauma

Hematology Ortho Surgery of the Spine

Medical Genetics Obstetrics & Gynecology

Radiology - Diagnostic Plastic Surgery

Radiation Oncology Thoracic Surgery

Urology

Vascular Surgery

OtolaryngologyGMEC 6-25-2015 3

* briefly suspended Dec ‘14

Specialties Required to Track Proceduresw/o ACGME Logs

• MANY• If case or procedure minimums are defined

but no formal ACGME log, the PD should develop internal logs or other tracking systems with sufficient detail to capture and document the requirements.

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NAS

Data-driven review of programs

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Case/Procedure Log UsesProgram Director Trainee & Graduate’s

CredentialingRRC

Aids in verifying trainee competence to perform procedure or practice

Verification of clinical experiences

Quality of the program

Balanced distribution of learning experiences

Hospital Privileges % of program surgical or clinical volume exposure

Fulfills multiple competencies

Program %ile compared to national

APE, Self-Study, Accreditation SV

Trend reports

Program’s equitable distribution of experiencesComplement Changes

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Case Log Resources for the PD

• RRC Website– acgme.org

• Specialty Case Log FAQs• ACGME (weekly) Communications• Specialty Society Meeting Presentations

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PD Resources

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Case Log References

Program Director’s Guide Trainee User Guide

**Other Case Log Changes and FAQs may be posted on specialty’s ACGME siteGMEC 6-25-2015 9

Program DirectorTips

• Familiarity with specialty RRC terminology– Minimum #, key indicator case category, index category,

common CPT codes and CPT Code Mapping• Know the thresholds

– Including RRC revisions

• Develop process for tracking trainee compliance• Document Trainee & PD review

– At least semi-annually, quarterly for some specialties.• Review ACGME statistical reports annually

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Program DirectorTips

• Resident Level of Participation matters– Who may take credit for the operation or component– Must demonstrate progressive responsibility

• Examples– Urology

• Surgeon, 1st Assistant, Teaching Assistant

– Oto • Resident Assistant, Resident Surgeon, Resident Supervising Surgeon

– Ortho • Level 1(primary or supervising)• Level 2 (assistant)

– Neurological Surgery• Assistant Resident Surgeon, Senior Resident Surgeon, Lead Resident Surgeon

– Dermatology• Assistant/Observer, Primary Provider, Resident Surgeon

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ACGME Case Log Statistical Reports

• Graduate Resident Case Log Reports– Available annually, September to November– Aggregate Program, Resident, National Reports– Reviewed by RRC

**PD (and Program) Review Annually**

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Annual Aggregate Report

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Annual Aggregate Program Report

PD review:Is case volume adequate? Is this due to incomplete trainee documentation?Is additional education or are guidelines required? Add to semiannual feedback.

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Graduate Resident Aggregate Report

Threshold for RRC concern 15th%ileGMEC 6-25-2015 15

Program DirectorTips

• Minimums – reflect the lowest acceptable clinical volume of procedures

performed per resident/fellow for program accreditation– Only a fraction of the total operative or clinical experience expected

of a resident/fellow• Program Directors

– should ensure that reporting of procedures and clinical experiences does not end once minimum numbers are achieved by a resident/fellow.

• Residents/Fellows – should continue to enter all procedural activity during their

educational programs, even if they have personally achieved these minimum numbers.

From 2012 ACGME memoGMEC 6-25-2015 16

Expectations of the PD

• Provide clinical experience– Review institutional, departmental, faculty resources, and

patient mix– Develop rotation and clinical assignment schedules to assure

requisite experiences• Provide Trainee Education related to case logs• Annual Case Log Set Up

– Enroll New Trainees—passwords sent directly from ACGME– Update Continuing Trainees– Update Faculty Supervisors– Update Participating Sites

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Expectations of the PD

• Track the Data– Regular reminders to trainees to complete the requirement– Review case log reports and provide feedback to trainees, at

least semi-annually. Some require quarterly. – Recognize and address imbalances in clinical experiences.– Confirm that experiences documented by the trainees reflect

the institutional resources (ex. cannot document a procedure that is not conducted in their learning environment).

• Year End Archive – Electronically Submit Case Log Reports to ACGME when

required

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Questions?Discussion…

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